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Review options may threaten stability of medicines sector

Members of the Medicines Partnership of Australia (MPA), the nation’s pharmaceutical supply chain peak body, have raised their concerns about the future stability of the industry in formally responding to the Interim Report by the Review of Pharmacy Remuneration and Regulation.

The Interim Report proposes options for broad and far-reaching changes to the nation’s pharmaceutical industry model; changes that threaten the stability of a system that has delivered for Australian patients over a long period of time and is not in need of a major overhaul, according to MPA members.

“Many of the options put forward in the Interim Report represent drastic and unnecessary change to a community pharmacy model that is for the most part, delivering well for Australians,” MPA Chair Donna Staunton said.

“Should the Review proceed on its current trajectory, negative impacts would be felt right across the pharmaceutical supply chain, ultimately increasing prices and reducing choices for consumers, and threatening patient accessibility to critical medicines.”

The Pharmacy Guild of Australia was particularly scathing in its response to the Interim Report, describing the Review as a lost opportunity to build upon a community pharmacy model that works extremely well, enjoys widespread support and is fiscally sustainable.

“The Review has been hijacked by a combination of ideology and economic theorising leading to conclusions that would dismantle if not destroy the tried and tested, mature community pharmacy model, forcing the closure of an estimated 1,700 community pharmacies with major losses of jobs, and an irreversible corporatisation and commoditisation of medicines related care,” Pharmacy Guild of Australia President George Tambassis said.

“The Guild has come to the conclusion that the Review is so fundamentally flawed and inherently damaging that it cannot and should not be relied upon by government as a credible input on the key issues of dispensing remuneration, pharmacy Location rules, the medicines supply chain or future community pharmacy agreements.”

In its response to the Interim Report, the peak national body for pharmacists, the Pharmaceutical Society of Australia (PSA) National President Dr Shane Jackson said, “Clinical services delivered by pharmacists, especially dispensing, need to be seen through a health lens and not an economic lens.

“Dispensing is a core clinical activity performed by the majority of pharmacists across the country. We need to build on this core role, and expand on the services available for community pharmacists to help their patients,” Dr Jackson said.

“Medicines Australia is not persuaded that a case for broad-ranging or radical reform has been made. Many of the options are quite radical, and would provide major disruption to a system that has served Australia well for many years,” Mr Catelin said.

“Rather than embarking on major reforms that would overturn many successful arrangements and lead to great unpredictability, Medicines Australia believes that incremental changes should be explored to make the existing systems work more efficiently,” Mr Catelin added.

In its response, the National Pharmaceutical Services Association (NPSA) outlined several general and specific concerns with the Interim Report’s findings, which fail overall to sufficiently recognise the complex, interdependent relationships that exist across the pharmaceutical supply chain and for the wholesaling industry in particular.

The Interim Report outlines three alternative options relating to the distribution of medicines to community pharmacy. The Review Panel’s preferred alternative (6-1) suggests putting the obligation of medicine delivery directly on manufacturers through a panel of distributors, while the second (6-2) retains the Community Service Obligation (CSO). The last of the three alternatives (6-3) suggests a “separate review of the CSO to ensure current arrangements demonstrate value for money”.

“Implementing a Manufacturer Distribution Model offers no obvious benefit and has significant drawbacks, including greater regulatory burden for government; greater administrative burden for pharmacy; increased risks to medicines availability due to diminished system redundancy; greater complexity across the supply chain and the potential for market power imbalance,” NPSA Chair Mark Hooper said. “It is not supported by NPSA and we are yet to find an industry association in the entire medicines sector who does,” he added.

“We are talking about a critical medicine supply chain that underpins the Government’s own National Medicines Policy (NMP). In the interests of Australian consumers and our community pharmacy customers who are dependent on it, CSO wholesalers remain committed to finding a workable outcome for Government and sustainable remuneration for the sector.”

The Generic and Biosimilar Medicines Association similarly expressed concerns about a Manufacturer Distribution Model in its response, noting that it will threaten commercial viability for manufacturers of generic medicines.

“Placing the onus for distribution on suppliers of generic medicines will only add to the cost of doing business. It will shift the scale towards commercial unviability and therefore cessation of supply for a significant number of generic medicines that Australians rely on to keep them well. It may also hinder competition, tipping the scale heavily in favour of larger manufacturers,” GBMA CEO Belinda Wood said.

The GBMA also strongly disagrees that tendering for generic medicines would improve supply chain efficiency and reduce costs to the Australian community. Ms Wood said, “a tendering system for generic medicines poses more risks for Australian consumers than benefits. It will only reduce patient choice, cause medicine shortages and rationing, destroy investment in this country, and irreparably damage the sector that seeks to make medicines affordable.”

While not as staunchly opposed, the Australian Self Medication Industry (ASMI) called for further assessment of any option relating to the tendering for the listing of generics. ASMI also expressed concern about increased regulation around the sale of Complementary Medicines (CMs).

“ASMI supports education and improved health literacy of consumers but does not believe separating CMs within pharmacy is an effective strategy due to the multiple market channels they are available through and may lead to a misconception that they carry no medical efficacy,” ASMI Chair Lindsay Forrest said.